MENDOCINO COLLEGE
REGISTERED NURSING
PROGRAM
1000 Hensley Creek Rd, Room 6520
Ukiah, CA 95482
707-468-3099
APPLICATION HANDBOOK
FOR FALL 2016
ADMISSION
Available February 1, 2016
Applications Accepted 2/1/16 to 03/10/2016
In Person Drop Off Times: M-Th 9-12:30 & 1:30-4
Revised 01/26/2016
TABLE OF CONTENTS
INTRODUCTION
The Registered Nursing Program Application Handbook ......................................................... 1
NURSING PROGRAM PHILOSOPHY AND OBJECTIVES
Philosophy ................................................................................................................................ 2
Statement of Purpose ................................................................................................................. 2
Program Goals ........................................................................................................................... 2
REGISTERED NURSING DEGREE PROGRAM
RN Associate of Science Degree Program ................................................................................ 3
Important Notices ...................................................................................................................... 4
Nursing Major Courses.............................................................................................................. 4
ENROLLMENT AND SELECTION POLICIES AND PROCEDURES ................................... 4
Minimum Requirements for Application .................................................................................. 5
Step-by-Step Procedure for Application.................................................................................... 7
Selection Criteria ....................................................................................................................... 9
Post Acceptance Follow-Up .................................................................................................... 12
GENERAL INFORMATION FOR NURSING APPLICANTS
Prior Misdemeanor or Felony Convictions ……………………………………………………. 10
Estimated Program Expenses ………………………………………………………………….. 14
Core Nursing Performance Standards ……… ……………………………………………….. 15
Application Check-Off Sheet …………………………………………………………………. 16
Nursing Department Application ……………………………………………………………… 17-18
Physical Requirements Application Disclosure Statement …………………………………… 19-20
Confirmation Statement……………………………………………………………………….. 21
THE REGISTERED NURSING PROGRAM APPLICATION HANDBOOK
This Application Handbook provides prospective students with basic enrollment instructions for the
Registered Nursing Program.
The Nursing Program Enrollment Policy was developed to comply with Title 5 regulations, with input
from the Nursing Program Advisory Committee and Mendocino College students, faculty, counselors,
Deans, the Director of Admissions and Records, the Vice President of Academic Affairs, as well as
the California Community College Chancellor’s Office.
This handbook is designed to assist the applicant in becoming better acquainted with the policies and
procedures governing entry into the Registered Nursing program. Mendocino College reserves the
right to revise Associate of Science (A.S.) Degree Requirements and selection procedure at any time.
It is the applicant’s responsibility to keep informed of the specific requirements and selection
procedures by which he or she will be evaluated.
Applicants are encouraged to apply to the program only if they are serious in their intent to complete
the program to which they are applying. The current admission protocol involves limiting enrollment
to qualified and complete applications.
An individual is ineligible for nursing program enrollment if previously dismissed from any RN
or other Allied Health program for behavior posing a threat to patient safety or if they
previously have had a license/certificate that has been removed/disciplined for any reason
(EMT, paramedic, LVN, CNA, phlebotomist, Xray tech, MA). If you have left another program
for any reason, it is your responsibility to obtain a statement from their Director indicating your
readmission status to that program (that you would be able to be readmitted if you reapplied) and
there were no safety related issues causing your dismissal. This statement must either be included
with your application or sent directly to Mendocino College Nursing Dept, 1000 Hensley Creek Road,
Room 6520, Ukiah, CA 95482. If sent directly to the Nursing Department this documentation must
be received by the close of the specified application period for an application to be considered.
Program planning, advising, and career counseling are provided by the Mendocino College
Counseling Office. The nursing career counselor is Steve Crossman (468-3048). The applicant is
urged to make an appointment with a counselor early in their academic planning process. Call the
Counseling Office for more information – in Ukiah (707)468-3048; Lake Center (707)263-4944;
Willits Center (707)459-6224.
The application, selection, and admission processes for the Nursing Program are coordinated by the
Nursing Department and any inquiries regarding entry should be directed to this office at (707)4683099.
1
NURSING PROGRAM PHILOSOPHY
The philosophy of the Mendocino College Registered Nursing Program supports and implements the
mission statement of Mendocino College. The faculty members believe that a sound nursing
education program is built on concepts relating to the individual, health/illness, the environment, and
nursing which includes nursing education.
Nursing faculty members recognize the individual as a holistic, unique and complex being who
constantly responds to changing environments in biological, psychological, social, cultural and
spiritual domains. Individuals develop and interact within the context of their family, community,
and social environments. People possess dignity, self-worth and the inherent right to assume
responsibility for the development of their own potential. Additionally, individuals are entitled to
information that allows them to make informed choices regarding their health care and to become
active participants in decisions regarding their well-being. Individuals hold diverse values and beliefs
and exist in different social and physical environments all of which may have an impact on an
individual’s state of health.
Each learner is recognized as having unique experiences and background. Faculty members are alert
to individual differences due to gender, cultural background, goals, and learning styles. Support
services, including counseling, financial aid, and a wide variety of learning resources, are an integral
part of the system available to accommodate the individual needs of the students.
The student is considered an active participant in both the educational experience and the evaluation
of the experience. The student holds the responsibility for classroom preparation and attendance, for
engagement in active listening and analysis, completion of assignments and evaluation of learning
experience.
STATEMENT OF PURPOSE
The Mendocino College Nursing Program is designed to provide the individual the opportunity to
obtain technical skills and a comprehensive education and to foster within each graduate a
commitment to lifelong learning and professional development.
At the conclusion of the program, students will be able to:
1. Perform the duties and fulfill the responsibilities of an entry-level Registered Nurse.
2. Qualify for the state board examination (NCLEX-RN) leading to licensure according to the
regulations of the California State Board of Registered Nursing.
3. Qualify for an Associate of Science Degree in Registered Nursing
PROGRAM GOALS
1. Prepare students to practice the art and science of professional nursing in the most ethical and
competent manner possible, within the scope of practice of the Registered Nurse.
2. Build and maintain effective partnerships with local health care agencies, in order to support
students’ education and help meet employers’ on-going needs for prepared, entry-level
professional nursing staff.
3. Instill in program graduates a commitment to their continued professional development,
whether to maintain licensure or to advance educationally.
2
RN ASSOCIATE OF SCIENCE DEGREE PROGRAM
The Registered Nursing Degree Program requires two academic years, or four semesters, in addition
to the completion of the prerequisite courses, non-nursing breadth requirements, and competencies.
Graduates will earn the Associate of Science Degree in Nursing on completion of designated courses
and competency requirements. Communication, language, natural and social science, and nursing
courses must be completed with a grade of "C" or better to be eligible for licensure requirements of
the State Board of Nursing.
COMPETENCIES REQUIRED BY MENDOCINO COLLEGE FOR GRADUATION FROM
REGISTERED NURSING ASSOCIATE OF SCIENCE PROGRAM
GENERAL EDUCATION & PREREQUISITE COURSES
Competency Areas
Required Prerequisite and
Recommended General
Education Courses
Unit
s
Competency 3:
Math
Area A: Natural Science
MTH 56: Intermediate Algebra
or equivalent
BIO 230: Anatomy
BIO 231: Physiology
BIO 259: Microbiology
3
(may test out via placement test)
4
4
4
NURSING PREREQUISITE
Anatomy, physiology and microbiology must
have been completed within the last 10 years
if student received a grade of "A" or "B" in
the course. If student received a grade
of "C" the class must have been completed
within the past 5 years. (At least two of these
courses must be completed prior to application
to program)
Area B-1:
American Institutions:
Area B-2: Soc/Behavioral
Science
See Catalog for qualifying
courses
PSY 205: Introduction to
Psychology
3
Institutional Requirement
Cross Cultural
Area D-1 & Competency 4:
Language:
English Comp.
Area D-2: Communication/
Analytical Thinking
See Catalog for qualifying
courses
ENG 200: Reading and
Composition I
3
3
NURSING PREREQUISITE (must be
completed prior to application to program)
SPE 200: Intro to Public
Speaking
3
Area C-1 & Competency 1 :
Humanities
SOC 201: Modern Social
Problems
3
Competency 2: Wellness
HLH 114: Foods & Nutrition
or HLH 115: Therapeutic
Nutrition
HLH 200
3
NURSING PREREQUISITE
SPE 210: Interpersonal Communication will
also satisfy this requirement.
NURSING PREREQUISITE SOC 202
(Racial/Ethnic Relations); ANT 201 (Cultural
Anthropology) may also satisfy this
requirement (see counselor).
NURSING PREREQUISITE
HLH 114 also meets Competency 2 requirement
Institutional Requirement:
Health
3
3
3
Comments
NURSING PREREQUISITE
PSY 215: Psych of Personal Growth or
PSY210 Lifespan Developmental Psych, or
CDV 200: Psych of Development, Infancy to
Adolescence, will also satisfy this requirement.
Note: This institutional requirement can be
waived once you enter the nursing program. An
approval by petition to substitute the NUR
courses will be done after formal admission to
the nursing program.
IMPORTANT NOTICES:
1.) All potential applicants must attend a mandatory pre-application workshop at the Ukiah
campus. The workshop dates and times can be found on the Mendocino College Nursing
webpages. An applicant need only attend one workshop.
2.) IT IS STRONGLY SUGGESTED THAT STUDENTS MEET WITH THEIR ACADEMIC
COUNSELOR BEFORE ENROLLING IN CLASSES. Four-year universities have different
requirements for lower division general education and major prerequisites. It is critical that you be
aware of these differences, so that you are not forced to repeat courses, or take unnecessary courses, if
you wish to continue with a 4-year degree at a later time.
Also: A joint venture with Sonoma State University for ADN to MSN requires that a student
successfully complete a statistics course (from math department) to be eligible to enter the MSN
program. Therefore, if you are interested in the MSN degree we recommend taking statistics along
with the other general education courses.
NURSING MAJOR REQUIRED COURSES
UNITS
COURSE
COMMENTS
NUR 102: Nursing Concepts & Skills I
10 Prerequisite: Formal Admission to the RN Program. Corequisite: NUR 105.
NUR 105: Pharmacology I
1 MTH 55 Highly recommended. Corequisite: NUR 102.
NUR 112: Nursing Concepts & Skills II
10 Prerequisite: NUR 102, or current LVN license and approval
of Director of Nursing Program; Co-requisite= NUR 115.
NUR 115: Pharmacology II
1 Prerequisite: NUR 105, or current LVN license and consent
of Nursing Program Director.
NUR 116: Intro to Nursing Seminar
1
NUR 122: Complex Med Surg Nursing I
8 Prerequisite: NUR 112 or NUR 50; Co-requisite NUR 125
NUR 121: Leadership & Management I
1 Prerequisite: NUR 112 or NUR 50; Co-requisite NUR 122
NUR 125: Pharmacology III
1 Prerequisite: NUR 115 or NUR 50
NUR 126: Nursing Seminar I
2 Prerequisite: NUR 116 or NUR 50
NUR 132: Complex Med Surg Nursing II
8 Prerequisite: NUR 122; Co-requisite= NUR 135
NUR 131: Leadership & Management II
1 Prerequisite: NUR 121; Co-requisite = NUR 132
NUR 135: Pharmacology IV
1 Prerequisite: NUR 125
NUR 136: Nursing Seminar II
2 Prerequisite: NUR 126
TOTAL NURSING MAJOR UNITS
TOTAL AS DEGREE UNITS
47
83
All GE courses must be completed by the end of the semester in which application is
submitted and at time of application student must have at least two of the three major
sciences and the English requirement completed (for admission formula purposes).
ENROLLMENT AND SELECTION POLICIES/PROCEDURES
Candidates are selected for the Mendocino College RN Program from among those applicants who
meet the Minimum Requirements. Meeting minimum requirements will not guarantee admission. All
qualified applicants will be evaluated according to an admission formula (described below).
Applicants scoring at or above 80% using the formula will then be entered into a lottery draw for final
selection (random generated selection). Those selected will be sent an offer of admission and must
show TEAS V test results with a composite score of 62% or higher (if not already submitted with
application). Admission to nursing courses will not be granted without a passing score on the TEAS
4
V by the deadline stated in the admission letter. The TEAS V exam can be taken at the Ukiah
campus, or at other sites listed on the ATI website (see www.atitesting.com). If you are considering
submitting an application you should be scheduling and preparing for the TEAS V exam now.
A short alternate list will be maintained in the event that seats become available prior to the beginning
of classes. Those on the alternate list are also required to pass the TEAS V test with a composite
score of at least 62%. If you have taken the TEAS V test please include a copy of your results with
your application to the program.
All potential students are encouraged to apply to more than one nursing program due to the fact
that far more applications for such programs are received than schools can accommodate. We
accept 18 students per year into the RN program. We also maintain a short alternate list of
applicants in the event that any of the 18 applicants decline admittance.
MINIMUM REQUIREMENTS FOR APPLICATION
1. U. S. Citizen or permanent residency status prior to submission of application.
2. Successful completion of 12th grade education, as evidenced by copy of high school diploma,
or copy of G.E.D. certificate, or equivalent as follows:
 A degree from any junior college, college, or university accredited by a state
agency authorized to accredit such institutions (degree posted on transcript)
3. Successful completion of prerequisite courses, by end of semester in which you submit
application, with a grade of “C” or greater and cumulative college GPA of 2.5 or greater.
Note: Courses taken credit/no credit or pass/fail will receive point value of a “C” when GPAs
are calculated.
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




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BIO 230 Anatomy
BIO 231 Physiology
BIO 259 Microbiology
HLH 114 Foods & Nutrition or HLH 115 Therapeutic Nutrition
SOC 200 Sociology, or SOC 201 Modern Social Problems, or SOC 202 Racial and
Ethnic Relations, or ANT 201 Cultural Anthropology
ENG 200 Reading Composition
SPE 200 Intro Public Speaking, or SPE 210 Interpersonal Communication
PSY 205 Intro to Psych, or PSY 215 Psych of Personal Growth, or CDV 200
Psychology of Development: Infancy through Adolescent
Science Course Recency Anatomy, physiology and microbiology must have been
completed within the last 10 years if the student received a grade of “A” or "B" in the
course. If the student received a grade of “C” the class must have been completed within
the past 5 years. No online science courses will be accepted as prerequisites. There is no
longer an option to waive the recency requirement for these courses.
4. Completion of all General Education courses to meet college graduation requirements by
the end of the semester in which you are submitting application and completion of at least
5
two of the three science prerequisites and the English prerequisite prior to the semester in
which you are applying.
5. Completion of application to Mendocino College Nursing Department within posted
application period. Incomplete and/or late applications will not be considered for
admission. It is the responsibility of each applicant to make sure their application is
complete before submission. The Nursing Department will not review applications for
completeness at the time they are submitted. You should review the application packet to
ensure you have all components prior to submitting.
6. Attendance at one Nursing Pre-Application O r i e n t a t i o n Workshop at Mendocino
College. Workshop dates are posted on the Nursing Program web page
h t t p : / / w w w . m e n d o c i n o . e d u / d e p a r t m e n t / n u r s i n g P re-registration is mandatory.
Must arrive on time, with photo ID, and attend entire workshop. You will receive a
completion/proof of attendance form that must be submitted with your application. KEEP
A COPY OF YOUR ATTENDANCE FORM in case you reapply at a later time.
7. One official sealed transcript for all coursework taken (outside of Mendocino College
courses) must be submitted to the Mendocino College Nursing Department.
Your
application is not considered complete until all official transcripts have been received.
You may request that official transcripts from other colleges be sent to you, and then
submit them with your application as long as they remain in sealed envelope from school.
Open or unofficial transcripts will not be accepted.
8. Students with high school and college transcripts from institutions outside the U.S. will need
to have these transcripts evaluated for U.S. equivalency. All foreign student transcripts must
be officially evaluated by:
IERF, Inc.
P.O. Box 66940
Los Angeles, CA 90066
OR
ERES, Inc.
777 Campus Commons Rd., Ste.200
Sacramento, CA 95825-8309
Note: It is the responsibility of the applicant to obtain foreign transcript evaluation
prior to application. This process can be lengthy and costly, so plan accordingly.
An official copy of the transcript(s) and evaluation must be submitted at the time
of application to the Nursing Department as well as Admissions and Records.
9. Successfully passing the TEAS V Exam with a composite score of 62% or above.
6
STEP BY STEP PROCEDURE FOR APPLICATION
Step 1:
Carefully read the entire Registered Nursing Program Application Handbook
Step 2:
Attend a pre-application workshop (offered several times during each academic
year). Submit workshop certificate with application and keep a copy for yourself
in case you need to submit an application the following year.
Step 3:
Send for official transcripts from all colleges/universities attended (other than
Mendocino College). You can request transcripts be sent to you or directly to the
Nursing Department at Mendocino College (Mendocino College Nursing
Department, 1000 Hensley Creek Road, Ukiah, CA 95482). Transcripts must be
sealed in the original envelope from each school. Transcripts from outside the U.
S. will need to be submitted with written evaluation from IERF or ERES (or
comparable agency).
Step 4:
Step 5: Obtain a copy of your high school diploma or GED certificate to submit
with your application. Note that this step is not applicable if you have a previous
college degree posted on an official transcript submitted to the Nursing
Department.
Step 5:
Prepare a COMPLETE application packet to the Nursing Department containing:
 Enrollment Application (completely filled out)
 One official set of sealed transcripts from all colleges other than
Mendocino College (unless sent directly to Nursing Department from
those schools)
 Completed Physical Requirements Disclosure Statement
 Signed Confirmation Statement
 Signed Recency Waiver for Science Courses (if applicable)
 Copy of HS diploma or GED (if college degree not posted on
transcripts)
 If born outside of US: copy of proof of permanent residency status
 Copy of valid CA Driver’s License
 Workshop attendance form
 Copy of TEAS V test (unofficial copy accepted)
Step 8:
Submit COMPLETE application packet (pages 16-20 of this packet – NOT
ENTIRE PACKET) to the Mendocino College Nursing Office (Mendocino
College, Nursing Department [Room 6520], 1000 Hensley Creek Rd., Ukiah, CA
95482) either by mail or in person. The application packet must be received
(NOT postmarked) in the Nursing Office by the due date as listed on the front of
this packet and should be prepared as follows:

Application materials are to be sealed in 9x12 or 10x13 manila envelope
with applicant’s first and last name clearly printed on the front of
envelope. Directly below you name: print the following: “RN
PROGRAM 2015-2017 APPLICATION”.
7

If mailing the application it is strongly recommended that you obtain
delivery confirmation from the Postal Service. Applications sent via mail
must be received (not postmarked by) in the Nursing Department by the
end of the application period. No applications will be accepted after
March 10th at 4:00 p.m..

If bringing the application in person, follow the above directions and
deliver during official application acceptance period.

If it is determined that minimum requirements have not been met, or if
application is incomplete, applicant will not be considered for admission.
Transcripts will not be returned to student.
Step 9:
Await written notification of admission decision from the Nursing Program. (four
to nine weeks after application period ends). Please do not call prior to nine
weeks regarding applications as this could further slow down the process. No
acceptance information will be given by phone either before or after
admission decisions are made. The Nursing Department makes every effort to
process applications in a timely manner and notify applicants as soon as possible
of their status.
Step 10:
If tentative admission offer is received, respond in writing a “Confirmation of
Acceptance” and complete a Background Check (form and instructions will be
included with admission offer) by an assigned date on decision letter. Any
admission offers that are not confirmed within the timeframe stated in the offer of
admission letter, and for which the Nursing Department does not receive
Background Check information within that same timeframe, will be void and the
space will be offered to another applicant.
Students must have clear criminal background checks to participate in
placement(s) in clinical facilities. Background checks are required for registration
in hospital clinical courses or hospital observation. The initial background check
satisfies this requirement during continuous enrollment in the program; should the
educational process be interrupted, a new background check will be required.
Any charges or known history that indicates emotional instability or problems
with decision making will result in an application being denied. Students may be
denied access to clinical facilities based on offenses appearing on the criminal
record, even if they occurred more than seven years ago.
Students will allow the Nursing Director at Mendocino College to have access to
their Background information. If the student’s record is not returned as cleared,
the student will be responsible for obtaining documents and correcting their
record. If this is not possible, the student will be unable to attend clinical
rotations. Clinical rotations are a mandatory part of nursing and allied health
education; therefore the student will be ineligible to participate in the program.
Step 11:
Upon receipt of clear background check and any other needed documentation you
will receive a formal admission letter and the student handbook with
directions/deadlines for other requirements (physical, registration, uniforms, etc).
8
Step 12:
After admission to the program, if you have not previously attended Mendocino
College, you will be directed to apply to the college and submit official transcripts
to A&R. Transcripts sent to Nursing Department for nursing admission will not
be sent to Admissions and Records.
Step 13:
A new student orientation meeting will be held prior to the beginning of courses.
At this orientation (different from the pre-application workshop) you will be
provided with further information regarding courses and requirements. This
orientation is mandatory and is usually held the week prior to the start of the Fall
semester.
REGISTERED NURSING PROGRAM SELECTION CRITERIA
Mendocino College will consider all applicants who meet the minimum requirements for
admission to the Registered Nursing Program. The number of qualified applicants, however,
usually exceeds the capacity of the class. In order to fairly select students, the Registered
Nursing program will follow certain admission procedures:
1. On submission of a COMPLETE application and workshop certificate number, the
application will be placed into the evaluation process.
2. Each applicant’s grades will be entered into a database for scoring according to a
standardized formula. The formula is derived from the “Predicted Probability of
Success” study by the CA Community College Chancellor’s Office. The formula
consists of weighting the following :
 Overall College GPA (for all college courses attended)
 College English GPA (ENG 200 or equivalent)
 Science Courses GPA (Anatomy, Physiology, Microbiology)
 Number of course repetitions in Core Science Courses (in order to pass these
courses). This counts negatively in the formula. Repetitions in order to
improve on a passing Science course will not count against a student, but the
original grade and course repetition grade will be averaged.
3. The above factors result in an applicant’s “score”. Any applicant that scores above 80
will then be placed into a randomization (computer based) lottery selection. Students will
be accepted according to this method (randomized) until all seats are filled for that class
cohort. A short alternate list will also be maintained for seats that may open prior to the
beginning of classes.
4. Applicants must have a TEAS V test score of 62 or greater. Information on the TEAS V
test can be found at www.atitesting.com and a study guide is available through their
website. A copy of the study guide is also available in the Mendocino College Library.
If a tentatively accepted student has not taken the TEAS exam prior to acceptance, they
will be offered one chance (date and time to be assigned) to take this at the Ukiah
campus. If the student cannot attend that seating of the exam, the application offer will
be void. If the student completes the TEAS V but does not pass with a score of 62 or
greater, a remediation plan will be developed by the program director. The remediation
plan must be successfully completed before re-testing. If the re-test is not successfully
completed, or the remediation plan not completed as assigned, the previous offer will be
9
void. If remediation is completed and re-testing is successful, the student will be granted
entry into the next incoming class.
5. Those chosen by lottery for the available seats will be required to submit a completed
background check (directions will be provided with admission letter). The following
offenses would prevent admission to the program as a student would not be eligible to
enter clinical training:
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








Murder
Assault
Sexual offenses/sexual assault or any crime where candidate is required to
register as a sex offender with state or federal government agencies
Felony possession and furnishing
Felony drug and alcohol offenses (without certificate of rehabilitation) or drug
related crimes such as drug theft, sales, distribution, manufacturing or
possession of controlled substances
Other charges involving weapons and/or violent crimes (including robbery,
burglary)
Class B and/or class A misdemeanor theft
Crimes involving theft, embezzlement, burglary, forgery, fraud, arson, identity
theft
Fraud
Crimes resulting in name being listed on any government sanctioned or debarred
list
Any charges that indicate emotional instability or problems with decision
making.
PRIOR MISDEMEANOR OR FELONY CONVICTIONS
Applicants should be aware of the provisions of the California Nurse Practice Act, which
requires the Board of Registered Nursing to review the history of previous misdemeanor
and felony convictions. In those cases where offenses bear a substantial relationship to
the nursing profession (drug related charges, theft, battery, driving while under the
influence, crimes against others), the Board can withhold licensure even though a student
may have satisfactorily completed nursing coursework. It is highly recommended that
potential students read information on the Board of Registered Nursing website before
they apply to take any nursing courses (www.brn.ca.gov).
6. Formal admission letters will include an acceptance form that must be returned to the
Nursing Department by a specified due date.
7. Any of the original seats slotted for that admission cycle that are not filled will be offered
to an alternate until all class seats are filled for that incoming class.
8. If an applicant is formally selected into the program and declines admission to that class
in writing by the response deadline, the applicant may be considered for admission to the
following class contingent on approval by the Nursing Program Director. If approved for
deferred admission in a consecutive year due to extenuating circumstances, this
procedure will apply ONE TIME ONLY. The applicant must speak with the Director of
the Nursing Program for approval to roll-over their acceptance to a subsequent cohort. If
10
approved, the applicant must submit an updated application for the subsequent class
during that application period in order to receive consideration. It is the student’s
responsibility to submit their updated application during the appropriate application
period.
The following guidelines apply to this option:
The applicant must have passed the entrance requirements as outlined in the
application packet, been offered admission by the nursing department, and
responded in writing with the “Confirmation of Tentative Acceptance,” indicating
they decline the offer of admission at that time.
The decline to offer of admission must be returned by the date indicated in the
admission letter and include a written request specifying the reason for the
deferment.
Any new entrance requirements that have been established since the original offer
must subsequently be met by the applicant. These requirements will be
communicated to the deferment student by the Nursing Director in a timely manner.
The student must submit a new application to the nursing program the following
year, and provide transcripts for any new coursework taken since the last
application.
The re-application must be received in the nursing office during the
formal application period to be considered valid (application availability
and due dates are listed online).
All other admission requirements such as background checks, health exam, and
TEAS V testing must be completed by deadlines that will be communicated in
the acceptance letter.
New updated background checks will be required at time of admission.
9. Failure to reply to an admission offer does not constitute a decline of the offer and as
such the applicant will not receive guaranteed admission to the next class but instead
must reapply with the general applicant pool and be subject to the lottery again.
10. Failure of a cleared Background Check result on file with the Nursing Program Director
by a stated deadline will result in the tentative offer of admission being withdrawn and
the applicant will have no rights to automatic admission to future classes.
11. All applicants not gaining admission will receive notification of their status and will need
to reapply for the next class if they wish to be considered for the next admission period.
No preference will be given to applicants who have applied for more than one admission
into the Nursing Program. Those who are on the initial admission list but fail to achieve
at least a 62% composite score on the TEAS V will be admitted to the following cohort if
they have subsequently passed the TEAS V test with at least a 62% after developing and
completing a remediation plan with the Nursing Program director. Failure to pass the
TEAS V test the second time will result in the offer of admission being null and void.
12. Those who were alternates for an incoming class, but no class seats were available, will
have two numbers placed in the following years lottery draw if they reapply.
11
POST-ACCEPTANCE FOLLOW-UP
Once accepted into the program, the student must be able to successfully complete each of the
following steps. If an applicant knows they would be unable to complete any of these
requirements, for any reason, they should reconsider applying at this time.
1. Pass a physical examination by licensed MD, FNP or PA and have documented satisfactory
physical and psychological health to participate in the program (cost of exam is responsibility
of student). This examination must assess the physical ability of the student to stoop, squat
and lift 50 pounds as these are integral parts to their clinical training. See physical
requirements disclosure form to follow.
2. Provide evidence of the following immunizations and lab tests (at student’s expense) to the
Nursing Department by the deadline as indicated in the admission letter.
 Current negative Mantoux intradermal tuberculosis (TB) skin test (one TB Test by
the August start date. A second TB test (2-step) will be required before beginning
clinical rotation. TBA) or Chest X-ray. The Mantoux intradermal TB skin test or Chest
x-ray will be repeated after 12 months in keeping with current Center for Disease Control
recommendations
 Evidence of current Tdap (Tetanus, Diptheria and Pertussis,) immunization within last 7
years.
 Evidence of administration of Hep B series completed within last 5 years.
 Copies of labs results showing positive titers (requires blood to be drawn) for
Rubella, Rubeola, Varicella, Mumps, and Hep B (if Hep B series completed more
than 5 years prior). Titers not showing immunity shall require that the student receive a
booster immunization and provide proof of immunization to the Nursing Department.
3. Provide copy of current American Heart CPR or American Red Cross card (Basic Life
Support for Health Care Provider). Current CPR must be maintained until graduation. Be
sure when taking CPR course that you are taking the BLS for Health Care Provider course,
which is different than a basic CPR class for non-health providers and/or rescuers. Any lapse
in coverage disallows the student from attending clinical courses and thus results in dismissal
from program.
4. Provide copy of current Professional Liability Insurance (malpractice insurance) with the
coverage of $1,000,000.00 for each occurrence, $3,000,000.00 aggregate. Insurance is
available online at www.nso.com and will need to be kept current until graduation. Choose
the option for student insurance on the website. Any lapse in coverage disallows the student
from attending clinical courses and thus results in dismissal from program.
5. Attend clinical hours involving day, evening, nights and/or weekend shifts. Eight hour shifts,
twelve hour shifts, and four hour shifts may be scheduled. Travel to facilities in adjacent
counties will be required and is the responsibility of the student. As such, each student needs
to have a dependable car at their disposal and a valid CA driver’s license and applicable
insurance as required by law.
6. Clinical facilities have the right to perform drug screens on student’s using their facility.
Any student who fails a drug screen (including not obtaining the test as assigned) will be
12
unable to complete the clinical requirements and thus will be dismissed from the program.
Drug screens will be completed during first semester initially (paid for by student) and
repeated periodically throughout the program (paid for by facilities).
7. Latex Allergy: Medical equipment often contains latex. Students with known latex allergies
must use extra caution when working with such equipment. Mendocino College will make
available latex free products in the lab setting, if available, only with documented sensitivity.
It is the student’s responsibility to obtain their own products for use in clinical setting.
8. All nursing students are required to have a valid, stable, reliable email address and agree to
check this email regularly for updates and information. Most communication with students is
done via email when they are off site. Each email must be kept throughout the program so a
stable address is suggested. On campus email is available, as are other free email services
(e.g. gmail.com).
13
REGISTERED NURSING PROGRAM
ESTIMATED PROGRAM EXPENSES (To be used as an approximation only)
Nursing education is inherently expensive. If you aren’t able to afford nursing school, look for
scholarships or other sources of funding. Only apply to the program if you are confident that you
will be able to financially afford costs for all four semesters.
 First semester
–
–
–
–
–
–
–
–
–
–
–
–
Residency Tuition 12 units x $46
Health Fee
Student Rep Fee
ASMC Fee
Student Center Fee
Materials Fees
Textbooks
Background Check
Uniform and Equipment
Physical and Immunizations
CPR
Malpractice Insurance
– Total 1st Semester
 Second semester
–
–
–
–
–
–
–
–
$2550.00
Residency Tuition 12 units x $46
Health Fee
Student Rep Fee
ASMC Fee
Student Center Fee
Materials Fees
Textbooks
Oakland Children’s Pediatric Rotation - Travel
– Total 2nd Semester
 Third semester
–
–
–
–
–
–
–
$552.00
$ 10.00
$ 1.00
$ 4.00
$ 5.00
$260.00
$150.00
$250.00
$1232.00
Residency Tuition 12 units x $46
Health Fee
Student Rep Fee
ASMC Fee
Student Center Fee
Materials Fees
Textbooks
– Total 3rd Semester
 Fourth semester

$552.00
$ 10.00
$ 1.00
$ 4.00
$ 5.00
$358.00
$950.00
$ 41.00
$350.00
$200.00
$ 50.00
$ 29.00
$552.00
$ 10.00
$ 1.00
$ 4.00
$ 5.00
$260.00
$150.00
$982.00
–
–
–
–
–
–
–
Residency Tuition 12 units x $46
Health Fee
Student Rep Fee
ASMC Fee
Student Center Fee
Materials Fees
–
–
–
Application/Licensure Costs
Nursing Graduation Pin
Total 4th Semester
Graduation/NCLEX Fees
Estimated Total Costs of Nursing Program
14
$552.00
$ 10.00
$ 1.00
$ 4.00
$ 5.00
$260.00
$832.00
$350.00
$ 50.00 and up
$5996.00
CORE NURSING PERFORMANCE STANDARDS
The following Core Performance Standards identify essential eligibility requirements for
participation in the nursing program.
ISSUE
EXAMPLES OF NECESSARY
ACTIVITIES (not all inclusive)
STANDARD
Critical Thinking
Critical thinking ability sufficient
for clinical judgment
Identify cause-effect relationships in
clinical situations, develop nursing care
plans
Interpersonal
Interpersonal abilities sufficient to
interact with individuals, families,
and groups from a variety of social,
emotional, cultural, and intellectual
backgrounds
Establish rapport with patients/clients and
colleagues exhibiting a professional
demeanor. Ability to interact with peers,
patients, and faculty in a professional and
calm manner.
Communication
Communication abilities sufficient Explain treatment procedures, initiate
for interaction with others in verbal health teaching, document and interpret
and written form
nursing actions and patient/client
responses
Mobility
Physical abilities sufficient to move
from room to room and maneuver
in small spaces. Physical ability to
provide care of dependent patients
and assist with transport,
movement, and other aspects of
patient care.
Move around in patient's rooms, work
spaces, and treatment areas; administer
cardio-pulmonary procedures. Moving a
patient up in bed when they are unable to
do this for self. Assisting a patient with
ambulation.
Motor Skills
Gross and fine motor abilities
sufficient to provide safe and
effective nursing care
Calibrate and use equipment, lift and
position patients/clients. Percussion and
palpation during assessment. Do
dressing changes and administer
medications. Start an IV infusion.
Hearing and Speech
Auditory ability sufficient to
monitor and assess health needs.
Verbal ability sufficient to
communicate with patients and
other members of healthcare team.
Hears monitor alarm, emergency signals,
auscultatory sounds, cries for help.
Ability to hear and interpret phone
conversations with physicians. Clearly
communicates verbally with instructors,
peers, patients and other members of
health care team.
Visual
Visual ability sufficient for
observation and assessment
necessary in nursing care
Observes patient/client responses.
Correctly reads syringe information when
measuring medications.
Tactile
Tactile ability sufficient for
physical assessment
Perform palpation, functions of physical
examination and/or those related to
therapeutic intervention, e.g., insertion of
a catheter or giving an injection.
If you believe that you cannot meet one or more of the Core Nursing Performance Standards without
accommodations or modifications, you should discuss this with the Nursing Director. The nursing
program will determine, on an individual basis, whether or not the necessary accommodations or
modifications can reasonably be made.
* Adopted from the Southern Council on Collegiate Education for Nursing (SCCEN), 1993
15
MENDOCINO COLLEGE
REGISTERED NURSING
APPLICATION CHECK-OFF SHEET
(FOR YOUR CONVENIENCE…DO NOT INCLUDE THIS FORM WITH
APPLICATION)

Attend mandatory pre-application workshop

Read entire nursing application packet

Complete Nursing Department Application (Only turn in Application sheets as
indicated; not the entire application packet!!!)

Complete Physical Requirements Disclosure Form

Send sealed Official College Transcripts to the Nursing Department from all other colleges
attended (transcripts from other colleges can be included with your application if sealed. If
requesting transcripts from other colleges that are not included with your application, they
must be sent ATTN: NURSING DEPARTMENT in order to ensure they are received.)
*All transcripts from other colleges must be received in the Nursing Department before an
application is considered “complete” and applications must be complete by the end of the
application period for consideration. Any courses “in progress” at the time of application
should be noted in the application and a transcript with grade sent to the Nursing
Department as soon as course grades are posted.

Include copy of your valid CA Driver’s License

Include copy of HS diploma or GED (unless college degree is posted on transcript)

Include unofficial copy of TEAS V results

Complete and enclose signed Confirmation Statement
NOTE: ONLY COMPLETE APPLICATION PACKETS WILL BE CONSIDERED AND
PROCESSED. Do not send this entire packet. Send pages 17-21 ONLY please.
After submitting your application (by mail or in-person) contact the Nursing Department (707468-3099) if you have a change of address and/or telephone number. Failure to do so may delay
any information relayed to you regarding the status of your application and could prevent your
admission.
16
Mendocino College
NURSING DEPARTMENT
APPLICATION
Submit to:
Mendocino College
Nursing Department [6520]
1000 Hensley Creek Rd.
Ukiah, CA 95482
Application for (check one):
Be sure to attach your pre-application
workshop completion certificate! Keep a
copy for yourself!!!
APPLICATION FOR: (check one)

Registered Nursing Associate Degree Program
LVN to RN Degree Program
LVN to RN 30 unit option Certificate (as space available)
 Fall 2016
 Spring 2016 (LVN ro RN)
Have you previously submitted an application to the
Mendocino RN Program __no __yes _______
If yes, Year(s) ______________________
PERSONAL INFORMATION
Last Name
First Name
M.I.
Former (Maiden, Other)
Mailing Address
City
State
Zip
Physical Address (if different from above)
City
State
Zip
Date of Birth
Place of Birth
Soc. Sec. No.
email address (Internet access and computer use required of all students in program)
Phone # Where Can Be Reached
Alternate Phone or Message Phone #
EDUCATION (List High School, and then list all college(s) attended in chronological order)
All Institutions attended
School Name
Location (City/State)
From
Mo/Yr
17
To
Mo/Yr
Degree Received or Total Units
Completed
Print Name _______________________________________
NURSING PREREQUISITE COURSES
(White areas to be filled out by applicant, shaded areas are for Nursing Dept use only)
Course Area
Course Name and
Number of Course
(e.g. Reading
Composition ENG 200)
School
Completed or
Estimated
Sem.
Completed
Units
(month and
year)
Grade
For Nursing Dept
use only
Anatomy
Physiology
Microbiology
English
Nutrition
Sociology/Anthro
Psychology
Speech
Math (at level of
intermediate
algebra)
Composite score
Date Taken
TEAS V
I certify that all information provided in connection with this application is true, correct and complete. Providing false
information or omitting required information is fraud and grounds for denial of enrollment or immediate expulsion from the
Registered Nursing Program. I also certify that I have never held a nursing or other allied health license/certificate that has
been revoked for any reason.
__________________________________________
________________
Applicant Signature
Date Signed
18
Mendocino College RN PROGRAM
Physical Requirements
Application Disclosure Statement
Student Name: _____________________________________________________
Last
First
Middle
Associate Degree Nursing Program Physical Requirements: Please mark (X) for each requirement based on
your ability to do the requirement or not. If an accommodation is needed to meet the physical requirement, please
describe what accommodation is needed. Please see the Program Director if you require an accommodation.
An accommodation may or may not be available.
No
Some
Accommodation Accommodation
Needed
Needed (list)
Physical Requirement
STANDING/WALKING – 75% to 95% of work day spent
standing/walking on carpet, tile, linoleum, asphalt and
cement while providing patient care, getting medication
from the pharmacy, delivering lab specimens, monitoring
patient response, charting, and handling patient flow.
Approximate distance – 3 to 5 miles.
SITTING – 5% to 25% of work day spent sitting while
operating computers, answering the telephone, writing
reports, reviewing computer printout, charting, calling
doctors, and scheduling appointments.
LIFTING – 10% to 15% of work day spent floor to knee,
knee to waist, waist to waist and waist to shoulder level
lifting while handling supplies (5 pounds – 20 to 30 times
per shift), handling meds (2.5 pounds – 20 times per shift),
using trays (5 to 10 pounds), charting patient information (1
pound) and assisting with positioning patients on and off
gurneys and exam tables (average weight 200 pounds).
CARRYING – 65% of work day spent carrying at waist
level, tray (5 to 10 pounds) for up to 5 miles.
PUSHING/PULLING – 40% of work day spent
pushing/pulling while moving IVAC’s using carts,
relocating IV stands, utilizing crash carts, moving patient
beds to install IV’s, opening and closing patient doors and
stairway doors, opening refrigerator door, pushing/pulling
beds, gurneys, and wheelchairs, and moving office
equipment and furniture.
CLIMBING – 15% to 25% of work day spent climbing
stairs going to and from other departments, offices, and
homes.
BALANCING – 15% TO 25%, see climbing.
19
No
Some
Accommodation Accommodation
Needed
Needed (list)
Physical Requirement
STOOPING/KNEELING – 10% of work day spent
stooping/kneeling while retrieving medications from
refrigerator, loading tray from supplies on lower shelves,
using lower shelves of cart, stocking shelves, and retrieving
things from bedside stands, bathrooms, storerooms, etc.
BENDING – 20% of work day spent bending at the waist
while performing patient checks, gathering supplies,
assisting with patient positioning, adjusting patient beds,
adjusting exam table, tying and untying patient restraints,
bathing patients, and emptying tubes.
CROUCHING -- 2% of work day spent retrieving patient
belongings
CRAWLING – 2% of work day spent retrieving patient
belongs.
REACHING/STRETCHING – 35% of work day spent
reaching/stretching while providing patient care, gathering
supplies, operating the computer, disposing of dirty needles
in boxes, plugging in tubing over bed, assisting with patient
positioning, connecting equipment: CPM’s, SCD’s, PCA’s
and EKG machine, cleaning office equipment. Retrieving
patient files.
HANDLING – 90% hand-wrist movement, hand-eye
coordination, and simple firm grasping required.
FINGERING – 90% fine and gross finger dexterity
required.
FEELING – 90% normal tactile feeling required.
Sensitivity to heat, cold, pain, pressure, etc.
THROWING – None required
TWISTING – 15% of work day spent twisting at the waist
while gathering supplies and equipment, operating
equipment, bathing, and providing patient care.
TALKING – 95% average ability required. Fluent in
English. Absence of speech impediments, ability to
communicate with wide variety of people and styles, ability
to be easily understood.
HEARING – 95% ability to hear and interpret many people
and correctly interpret what is heard; i.e., physicians’ orders
whether verbal or over telephone, patient complaints,
physical assessment, fire and equipment alarms, etc.
SEEING/READING – 95% acute visual skills necessary to
detect signs and symptoms, coloring and body language of
patients, color of wounds and drainage, infiltrated IV sites,
and possible infections anywhere. Interpret written word
accurately, read characters and identify colors on the
computer screen, read physician orders in a timely manner
and interpret correctly, read lab values, reference texts.
I certify that the information on this form is truthful and correct to the best of my knowledge.
_____________________________ ____________________
Applicant
Date signed
20
Mendocino College
Registered Nursing Program
CONFIRMATION STATEMENT
Applicant Name (Please print)
___________________________________________
 I have attended the Mendocino College RN Program Pre-Application workshop within the
past 24 months.
I have read all of the material contained in the Nursing Program Application Handbook and
understand the application and selection process.
 I understand that the general education requirements for the A.S. Degree are subject to change
with each the publication of each year's new Mendocino College school catalog and that I should
check with Academic Counseling for degree clearance information. I understand that all GED
requirements must be completed by the semester in which application is submitted.
 I understand Mendocino College reserves the right to revise program requirements and/or
selection procedures at any time.
 I understand it is my responsibility to meet program requirements, ensure equivalency, follow
proper application procedures, provide transcripts, and keep informed on revisions regarding
degree requirements, program requirements, and selection process.
 I understand that if I submit an application packet that is not complete, or if I do not meet
application/program requirements, I will not be considered for admission and that the application
becomes null and void.
 I understand that I need a TEAS V score of ≥62 composite to be considered for admission.
 I understand that failure to submit the "Confirmation of Acceptance" by given deadline as
stated in admission letter will result in the admission offer becoming null and void.
 I understand that if I am admitted into the nursing program and I decline acceptance, my place
will go to a student on the alternate list. I also understand that if I choose, and decline in the
timeframe noted, that I can enter the next incoming class and that this offer will apply ONE
TIME ONLY.
 I understand that if I fail to successfully start coursework and leave for any reason, and wish
to re-enter, I will be considered as a new applicant and receive no special consideration.
 I understand that if accepted into the program I must have Internet access, have access to a
computer for coursework, and maintain a permanent email address throughout my enrollment.
_____________________________________________
Applicant Signature
21
_______________________
Date Signed